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Resumen Introduccion Ustekinumab, anticuerpo monoclonal que bloquea las interleucinas 12/23, ha demostrado en ensayos clinicos su eficacia para inducir y mantener la remision clinica en la enfermedad de Crohn (EC). Su efectividad y su seguridad en la practica clinica real es menos conocida y podria diferir respecto a los ensayos. Objetivo Evaluar en la practica clinica su efectividad y seguridad (pauta de induccion intravenosa esencialmente), como induccion y a largo plazo, en pacientes con EC refractarios a tratamiento biologico. Material y metodos Analisis retrospectivo multicentrico (6 hospitales aragoneses), que incluye a todos los pacientes (N = 69) con EC en tratamiento con ustekinumab (fuese con induccion intravenosa o subcutanea) que hubiesen alcanzado al menos 16 semanas de seguimiento. La respuesta o remision clinica se ha evaluado en las semanas 16, 24, 32 y 48 mediante el indice de Harvey-Bradshaw. Resultados Se han incluido un total de 69 pacientes, edad media 42 anos, 54% hombres. Un 89,86% (IC 95% [0,805, 0,949]) de los pacientes ha presentado mejoria clinica en la semana 16 (15,95% remision, 73,92% respuesta). En el seguimiento posterior dicha respuesta se ha mantenido. Se han identificado mediante un modelo de regresion ordinal la edad (OR 0,95, p = 0.028) y el habito tabaquico (OR 0,19, p = 0,027) como predictores de mala respuesta al tratamiento, mientras que la necesidad de cambio de biologico por efecto adverso (OR 96, p = 0,00017) y por perdida de respuesta secundaria (OR 7,07, p = 0,034) han sido factores predictores de buena respuesta. No se han reportado efectos adversos graves que obligasen a interrumpir el tratamiento con ustekinumab. Conclusion Ustekinumab es efectivo y seguro en la practica clinica real para lograr la induccion y el mantenimiento de la respuesta en pacientes con EC refractaria. El tabaco y la edad han mostrado ser predictores de mala respuesta, mientras que la indicacion por efecto adverso a biologico previo y por perdida de respuesta secundaria han mostrado ser predictores de buena respuesta.

Appendicular invagination is a rare situation, with an incidence of 0.01 %. The clinical presentation can be variable from acute appendicitis to chronic abdominal pain, intestinal obstruction by intussusception or simply appear as a radiologic or intraoperative finding. Endometriosis is the underlying cause of appendicular invagination in one-third of cases but the possibility of neoplastic pathology should always be considered in these cases.

Introduction Ustekinumab, a monoclonal antibody that blocks interleukins 12/23, has proven in clinical trials its efficacy in inducing and maintaining clinical remission of Crohn's disease (CD). Its effectiveness and safety in actual clinical practice is less known and may differ from trials. Objective To evaluate its effectiveness and safety in clinical practice (intravenous induction pattern essentially), such as induction and over the long term, in patients with CD refractory to biological treatment. Material and methods Multicentre retrospective analysis (6 hospitals in Aragon), which includes all patients (N=69) with CD undergoing treatment with ustekinumab (either with intravenous or subcutaneous induction), who had at least 16 weeks of follow-up. The clinical response or remission has been evaluated at weeks 16, 24, 32 and 48 using the Harvey-Bradshaw index. Results A total of 69 patients have been included, mean age 42 years, 54% men. A percentage of 89.86 (95% CI [0.805, 0.949]) of the patients presented clinical improvement at week 16 (15.95% remission, 73.92% response). In the subsequent follow-up, this response has been maintained. Age (OR 0.95, P=.028) and smoking habits (OR 0.19, P=.027) have been identified by an ordinal regression model as predictors of poor treatment response while the need for biological change due to adverse effect (OR 96, P=.00017) and due to loss of secondary response (OR 7.07, P=.034) have been predictors of good response. No serious adverse effects have been reported that forced them to stop taking ustekinumab. Conclusion Ustekinumab is effective and safe in real clinical practice to achieve induction and maintenance of the response in patients with refractory CD. Tobacco and age have been shown to be predictors of poor response, while the indication for adverse effect to previous biological and for loss of secondary response has been shown to be predictors of good response.